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Women's Health > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

Why has there been a increasing incidence in breast cancer?

A
  1. Changes in reproductive patterns
  2. Increased detection of early stages
  3. Increased mammography screening
  4. Decline in mortality
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2
Q

Where do researchers believe cancer starts?

A

junction of the duct and lobule

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3
Q

What are the risk factors for breast cancer?

A
  1. Gender - breast cells exposed to estrogen/progesterone
  2. Age - ⅛ <45, ⅔ > 55
  3. Genetics - BRCA1 and 2 abnormalities (5-10% hereditary)
  4. Race - Incidence, White > Black; Morbidity, black > white
  5. Overweight
  6. PMH - pregnancy, birth control, HRT, Breast feeding
  7. Alcohol use - 2-5 drinks per da = 1.5x risk
  8. Menstrual hx - early onset/ late meno
  9. Exercise hx - strenuous >4 hr/wk = reduced risk
  10. Family hx - 1st degree relative = 2x risk
  11. breast conditions - dense tissue
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4
Q

A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.

A

Estrogen and progesterone receptor test

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5
Q

A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER2/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab and pertuzumab.

A

Human epidermal growth factor type 2 receptor (HER2/ neu) test

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6
Q

What are the different description of breast cancer?

A
  1. Hormone receptor positive (estrogen and/or progesterone receptor positive)
  2. hormone receptor negative (estrogen and/or progesterone receptor negative)
  3. HER2/neu positive
  4. HER2/neu negative
  5. Triple negative (estrogen receptor, progesterone receptor, and HER2/neu negative)
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7
Q

How is breast cancer diagnosed?

A
  1. History
  2. Physical Exam
  3. Mammogram +/- US
  4. Needle Biopsy for histological confirmation
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8
Q

What are the types of biopsies?

A
  1. Fine Needle aspiration cytology
  2. Core or Trucut biopsy
  3. Surgical Biopsy
  4. Sentinel lymph node - injection of radioactive fluid by tumor to examine lymph nodes surrouding – the dye will go to the lymph node to check it out
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9
Q

What are the types of precancerous/ non invasive breast cancer?

A
  1. Ductal Carcinoma in-situ (DCIS)

2. Lobular carcinoma in-situ (LCIS)

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10
Q

What are the types of invasive breast cancer?

A
  1. Invasive ductal carcinoma (IDC)

2. Invasive lobular carcinoma (ILC)

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11
Q

What are the different qualifications for staging cancers according to tumor, nodes and mets?

A 
Tumor:
T1 < 2cm
T2 2-5cm
T3 > 5cm
T4 skin
Nodes:
N0 none
N1 mobile
N2 fixed
N3 clavicular, chest, arm edema

Mets:
M0 none
M1 distant

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12
Q

How do you stage cancer I-IV?

A 
Stage I = T1N0M0
Stage II = T2N0M0, T1-2N1M0
Stage III-A = T3N0-N2M0
Stage III-B = T3N0-N1-3M0, T4N1-3M0
Stage IV = T1-4N1-3M1	
5 year survival rate - 
0 100% 
I 100% 
II 86% 
III 57% 
IV 20%
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13
Q

What are surgical treatments for breast cancer?

A
  1. Prophylactic
  2. Mastectomy - Radical masectomy (removal of lymph nodes, pec minor, pec major, breast); Modified Radical Mastectomy (lymph nodes, breast, pec m lining); Sentinel node biopsy
  3. Breast Conservation and Irradiation - Lumpectomy with axillary dissection; Radiation necessary; Same cure rate as mastectomy; Sentinel node biopsy
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14
Q

When is breast conservation not appropriate?

A
  1. Multiple areas of cancer
  2. Previous radiation to breast
  3. Large tumor
  4. Small breast
  5. Patient’s preference for mastectomy
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15
Q

What are potential problems with sx intervention?

A
  1. Scar tissue, cording
  2. Decreased ROM/strength
  3. Scapular dysfunction
  4. Pain
  5. Surgical resection alone fails to cure 70% of cancers due to regional and distal metastases
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16
Q

What are the components of breast reconstruction?

A
  1. Immediate or Delayed
  2. Nipple tatoo
  3. Implants - Silicone, saline, combined with autologous
  4. Autogenous - Latissimus Dorsi muscle-skin flap; Transverse rectus abdominus muscle (TRAM); Free flap; Pedicle flap (via tunnel procedure)
17
Q

What are the effects of reconstruction on abdominal strength

A
  • lower abdominal strength and endurance - work on cores stability
  • women who receive PT after are significantly stronger
18
Q

What are ADRs to chemotherapy?

A
  1. Cardiac damage (Adriamycin)
  2. *Bone marrow suppression
    neutropenia
  3. Decreased aerobic capacity
    Weight loss/gain
  4. Premature menopause (osteoporosis risk)
  5. Chemo or HRT induced joint pain
  6. Peripheral neuropathy
  7. Cognitive dysfunction
  8. CRF (cancer related fatigue)
  9. Herpes Zoster
  10. Hair loss, nausea, loss of appetite
19
Q

What kind of therapy will a estrogen or progesterone receptive tumor receive?

A

Endocrine therapy

  • oophorectomy
  • tamoxifen - post chemo/ radiation drug for hormone receptive cancer

These tumors are faster growing but tx is easier bc they can work with meds that impact the hormone response

20
Q

What are ADRs of radiation?

A
  1. Fibrosis
  2. Chest wall adhesions
  3. Pain
  4. Desquammation (dry or wet) (not “burns”)
  5. Brachial plexopathy
  6. Neuropathies (local)
  7. Muscle impairments (intercostals, pect maj/minor, SA, lats, subclavius)
  8. Lung fibrosis
  9. Bone pain/damage
  10. Lymphedema
  11. Fatigue (anemia)
21
Q

What is the PT role in management of breast cancer?

A
  1. Screening and Education re: self checks
  2. Postoperative Management; pre-surgical management
  3. Restore ROM and Function
  4. Lymphedema Education/ management
  5. Prevention and Wellness
  6. Team approach
  7. Support
    - most women do not receive PT following cancer tx unless MS problems occur; analysis found that women who receive PT decrease mortality because of the effects of exercise. Max benefit for the equivalent of 3-5 hrs per week at avg pace
22
Q

What are red flags when screening for cancer?

A 
C - change in bowel or bladder habits
A - sore or bruise that doesn’t heal (not sure where the A is from?)
U - unusual bleeding or discharge
T - thickening or lump
I - indigestion or difficulty swallowing
O - obvious change in wart/mole
N - nagging cough or hoarseness
23
Q

What are indications that pain is caused by cancer?

A
  • any pain that does not decrease within 2 therapy sessions should be reported to Dr.
  • Out of proportion to demands of task
  • Pain with weightbearing
  • Pain in supine or rest (night pain)
  • Deep, ache, burning, sharp
  • Pain associated with neurological changes
24
Q

What are things to pay attention to when performing a systems review for MS-cancer specific?

A
  1. Soft tissue resection?
  2. Bone stability? - Bone density decrease, incr risk of fx; metabolic pathology resulting in demineralization and loss of micro-architectural stability of bone concomitant must be addressed in rehab programs
  3. Weakness - long thoracic nerve often involved (surgery and/or radiation); Secondary to chemo
  4. Steroids?
  5. ROM deficits - PT intervention early AAROM (below 90 1-2 weeks)
25
Q

What are the bone-avid cancers?

A 
BLT with Kosher Pickle:
Breast
Lung
Thyroid
Kidney
Prostate 
(and multiple myeloma)
26
Q

What are things to pay attention to when performing a systems review for Integ-cancer specific?

A
  1. Compromised from radiation or surgery?
  2. Decreased lymphatic flow (observe placement of scar)
  3. Wounds?
  4. Skin extrusion of primary tumor
  5. Reoccurrence of Mets to skins
  6. Numbness and Parasthesias (intercostobrachial nerve)
27
Q

What adresses fibrosis management?

A
  1. Deep tissue work/MFR (after sub-acute stage of healing) - ASTYM
  2. Manual stretching/AROM
    MLD, compression therapy
  3. Maintain ROM
  4. Prevention of chest wall adhesion
    - many women. have difficulty with tight thickened scar tissue, poor flexibility, swelling, and pain following mastectomy that is often left untreated
28
Q

Visible web of axillary skin overlying palpable cords of tissue; Incidence 6% (n=750) between 1-8 weeks s/p; Attributed to lymphovenous injury during ALND due to tissue retraction and/or patient positioning

A

Axillary web syndrome

29
Q

What should be included in a scapular assessment for BC patients?

A
  1. Active scapula retraction - Symmetry, Lag, compensation
  2. Scapular stability in weightbearing and retraction
  3. Protraction/retraction when upper trap eliminated
    - start with PNF of scap
30
Q

What should be included in tx for the scap?

A
  1. . Restore full AROM as soon as possible - Research supports early ROM
  2. Middle and lower trap PREs
  3. Consider muscular weakness secondary to nerve injury - Long thoracic, thoracodorsal, medial pectoral
  4. Train the scapula in weightbearing positions - Standing against wall; Standing leaning on table top; Quadruped
31
Q

What does lymphedema look like?

A

asymmetrical, no pain, c/o achy/ heavy, slow onset, progressive, pitting early stages, cellulitis common

  • use of US for early detection
  • resistance ex supported for tx
32
Q

What are manual therapy interventions at 0-3wks, 3-5wks, and 8wks?

A 
0-3 weeks:
- MLD prn
3-5 weeks:
- Scar mob
- Gentle MFR
- Manual UE stretching (upon drain removal for immediate reconstruction)
8 weeks:
- Scar friction msg
- MFR as tol; lateral chest wall, abdomen

Women's Health (4 decks)

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